Thinking About Cardiology A General Internists Perspective N
Thinking About Cardiology? A General Internist’s Perspective N. Lee, MD Associate Professor of Medicine (Clinical Educator) The Chicago Medical School Medical Director, Lovell FHCC Simulation Center
Caveat Emptor
The Choices
The Basic World of Cardiovascular Medicine Interventional • Coronary intervention • Electrophysiology • Percutaneous valve replacement Non-Invasive • Stress Tests/Nuclear Studies • Echocardiography • Office Cardiology (complex patients and unexpected walk-ins)
“I like Cardiology because. . . ” • Clinically stimulating—many options • Compensation • Lifestyle/Prestige • Surgical component • Other?
Perspective Changes with Time/Experience • “Last year I matched into a very competitive specialty for an IMG: categorical surgery. I was happy and amazed. Then I started my internship and realized I should have gone with my other choice – medicine. I started thinking, ‘This is it. I will rot in the OR for the rest of my life. ’ Then I realized I can live without the OR. I told my PD I wanted to switch. ” -Board. Vitals physician
Intangible Pre-requisites for Cardiology Ø Must be an Adrenaline Junkie • prerequisite to thrive • allows you to tolerate a life of interruption and inconvenience Ø Mesh Capability With Desire • know what you don't know and what you can't do • important to mesh your capabilities with your desires Ø Must Like Talking/Explaining to Patients, Family Ø Must carefully choose Soul Mate • “greatest attribute in a life partner is not their tolerance of your profession, it's their understanding that you are your profession” • find someone who knows that asking you to stop practicing medicine is like asking a musician to put down their instrument • Reciprocate by realizing that family life is not all about you
Adaptability: Life continues to happen. . . • “As a fellow, I was about to bolt out the door to the cath lab when I noticed spots on my 4 -year-old's face. Chicken pox blew through all my contingency plans. Innovation and perseverance are key in any profession, but you will need more of it to be a parent and a cardiologist whose schedule is full of procedures that took days or weeks to precertify and plan. ” Melissa Walton-Shirley, MD
Other Adrenaline-filled Specialties Why not Emergency Medicine? • little follow-up on how patients fared • incessant trail of pregnant 14 -year-olds with pelvic inflammatory disease and drug seekers who had "accidentally" flushed their oxycodone. Why not Pulmonary/Critical Care? • Don’t want to manage sepsis, mechanical ventilation • Work hours
Preparation as a Medical Student • Acquire/Develop strong fundamentals: heart sounds, ECG, clinical exam, pathophysiology, communication • USMLE scores: depends on the fellowship program • Get Research experience: for higher-power programs • Interviews: during PGY 2 -3 • Emotional Intelligence • Time Management skills: significant other
Title and Content Layout with Chart
Cardiology How Can I Help as a Medical Student - I?
Master the Fundamentals • Optimize delivery of oxygen • Optimize blood flow and perfusion
Pearls for the Medical Student as EMT
Blood Flow/Perfusion ACLS/Chest Compressions • CPR really should be called CCR (cardio-cerebral resuscitation) Ø Video Chest Compressions • When is it OK to stop compressions? Ø Focus on Compressions • ACLS Updates to know
How Do You Know What You Are Doing Is Actually Doing Something?
End-Tidal CO 2
Airway Management Pearls for MS-I Bag-Valve Mask Ventilation Oropharyngeal and/or Nasopharyngeal Adjunct Supraglottic Device/Laryngeal Mask Airway Endotracheal Intubation
Airway Management for MS-I
Bag Valve Mask Ventilation • Don’t “bag” faster if pulse oximetry is low. . . • Check pulse oximetry (%) and/or blood gas (Pa. O 2)
Ventilation Two-Hand Technique q Rescue Breathing: 1 breath every 6 seconds q CPR: 30: 2
Oxygenation
How Do You Know What You Are Doing Is Actually Doing Something?
End-Tidal CO 2 Validate that air is being delivered to the lungs
Bagging Too Fast BP Falls
Laryngeal Mask Airway (LMA)
Recognize STEMI vs NSTEMI
Summary
Airway Management Pearls for MS-I Bag-Valve Mask Ventilation Oropharyngeal and/or Nasopharyngeal Adjunct Supraglottic Device/Laryngeal Mask Airway Endotracheal Intubation
Blood Flow/Perfusion ACLS/Chest Compressions • CPR really should be called CCR (cardio-cerebral resuscitation) • When is it OK to stop compressions? • ACLS reminders
Questions?
Cardiology Survey Data Medscape 2018
Ethnicity, Diversity, Gender
Patient Contact Hours
Patient Contact Hours
Average Annual Salaries by Specialty
Compensation by Location: 2017
Compensation by Gender
Administrative Burden
Most Rewarding Aspect
Most Challenging Aspects
Choose Cardiology Again?
Choose Medicine Again?
References 1. Walton-Shirley, Melissa. To Be or Not to Be a Cardiologist. January 25, 2017. https: //www. medscape. com/viewarticle/874911#vp_2 2. Results and Data: Specialties Matching Service. 2018 Appointment Year. February 2018. http: //www. nrmp. org/wp-content/uploads/2018/02/Results-and-Data-SMS-2018. pdf 3. Medscape Cardiology Compensation Report 2018. https: //www. medscape. com/slideshow/2018 compensation-cardiologist-6009651#2 4. Medscape Malpractice Report 2017. https: //www. medscape. com/slideshow/2017 -malpractice-report-6009206
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